Probably a benefit in prescribing preoperative analgesics prior to orthodontic separator placement

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Pain is not uncommon after dental procedures. This can be linked with an increase in fear of dental procedures and the possible avoidance of treatment. This is of particular importance in children and adolescents and the use of pre-operative analgesics had been suggested as a way of reducing peri-operative pain. The aim of this Cochrane review was to assess the effects of preoperative analgesics for pain relief in children and adolescents undergoing dental treatment.

The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) MEDLINE, EMBASE, LILACS and the ISI Web of Knowledge databases were searched with no restrictions on language or date of publication. Reference lists of all eligible trials were checked for additional studies and Specialists in the field were contacted for any unpublished data. Randomised, cluster randomised and cross-over trials were included. Quasi-randomised studies were excluded.

Five trials (190 participants) were included. Three trials related to dental extractions and restorative treatment and two were related to orthodontic treatment. None of the trials were judged to be at low risk of bias.

  • Three trials compared paracetamol with placebo, Meta-analysis of the two trials showed a nonsignificant risk ratio (RR) for postoperative pain-related behaviours of which showed no evidence of a benefit in taking paracetamol preoperatively (52% reporting pain in placebo versus 42% in test group). One of these trials was at unclear risk of bias, the other at high risk.
  • Four trials compared ibuprofen with placebo. Three provided useable data. One reported no statistical difference in postoperative pain experienced by the ibuprofen group and the control group for children undergoing dental treatment.
  • Data from two trials were pooled to determine the effect of preoperative ibuprofen on the severity of postoperative pain. There was a statistically significant benefit, with regard to severity of postoperative pain, for giving ibuprofen preoperatively indicating a probable benefit for preoperative ibuprofen before this orthodontic procedure. However, both these trials were at high risk of bias.
  • Adverse events were only reported in one trial (one patient from the ibuprofen group and one from the placebo group reporting a lip or cheek biting injury).

The authors concluded

From the available evidence we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in prescribing preoperative analgesics prior to orthodontic separator placement.


Ashley PF, Parekh S, Moles DR, Anand P, Behbehani A. Preoperative analgesics for additional pain relief in children and adolescents having dental treatment. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008392. DOI: 10.1002/14651858.CD008392.pub2.




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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